Progress toward universal health coverage in ASEAN

Abstract

BackgroundThe Association of Southeast Asian Nations (ASEAN) is characterized by much diversity in terms of geography, society, economic development, and health outcomes. The health systems as well as healthcare structure and provisions vary considerably. Consequently, the progress toward Universal Health Coverage (UHC) in these countries also varies. This paper aims to describe the progress toward UHC in the ASEAN countries and discuss how regional integration could influence UHC.DesignData reported in this paper were obtained from published literature, reports, and gray literature available in the ASEAN countries. We used both online and manual search methods to gather the information and ‘snowball’ further data.ResultsWe found that, in general, ASEAN countries have made good progress toward UHC, partly due to relatively sustained political commitments to endorse UHC in these countries. However, all the countries in ASEAN are facing several common barriers to achieving UHC, namely 1) financial constraints, including low levels of overall and government spending on health; 2) supply side constraints, including inadequate numbers and densities of health workers; and 3) the ongoing epidemiological transition at different stages characterized by increasing burdens of non-communicable diseases, persisting infectious diseases, and reemergence of potentially pandemic infectious diseases. The ASEAN Economic Community's (AEC) goal of regional economic integration and a single market by 2015 presents both opportunities and challenges for UHC. Healthcare services have become more available but health and healthcare inequities will likely worsen as better-off citizens of member states might receive more benefits from the liberalization of trade policy in health, either via regional outmigration of health workers or intra-country health worker movement toward private hospitals, which tend to be located in urban areas. For ASEAN countries, UHC should be explicitly considered to mitigate deleterious effects of economic integration. Political commitments to safeguard health budgets and increase health spending will be necessary given liberalization's risks to health equity as well as migration and population aging which will increase demand on health systems. There is potential to organize select health services regionally to improve further efficiency.ConclusionsWe believe that ASEAN has significant potential to become a force for better health in the region. We hope that all ASEAN citizens can enjoy higher health and safety standards, comprehensive social protection, and improved health status. We believe economic and other integration efforts can further these aspirations.

Monitoring process barriers and enables towards universal health coverage within the Sustainable Development Goals

“…The same studies have identified economic crisis and the inflation as the main causes of socioeconomic problems [61,79]. Countries can ease the work of achieving UHC by mitigating the consequences of the economic crisis [119], concentrating on achieving economic growth [61,138,161], and by increasing the GDP share of THE [121,141].…”

“…Achieving UHC requires a powerful and multilateral support at the very top of the country's political system. The political and national commitment to support the healthcare system is a major influencing factor in implementing programs of UHC [51,124,141,155].…”

Risk entrepreneurship and the construction of healthcare deservingness for ‘desirable’, ‘acceptable’ and ‘disposable’ migrants in Malaysia

“…However, in a clear example of the 'fragile labour of welcoming' (Darling 2018, 224), after the Health Minister proclaimed in 2014 that foreigners were 'eating up our [Malaysian citizens'] medical subsidy' (Zuhrin 2014) foreigners were required to cover the real cost of their treatment at public health facilities, resulting in an exponential increase in medical costs for them. For example, a consultation with a public medical specialist costing citizens MYR5 (US$1) would cost migrants MYR60 (US$14) (Van Minh et al 2014). 2 In April 2017, the Ministry of Health announced a sharp increase in deposits for migrants seeking treatment at public hospitals, raising these by 130-230% (The Malay Mail Online 2017).…”

Networking for local and global change: The Southeast and East Asian Nursing Education and Research Network

“…Ensuring an adequate workforce to meet the health needs of the population is just the first step in ensuring health equity for the population. Malaysia, Singapore, and Thailand all offer universal health coverage with other ASEAN countries at varying stages of advancement toward universal health coverage (Van Minh et al, ). By using the resources at hand, such as the MRA on nursing services, a common goal to improve nursing throughout the region, and the desire to present a strong united economy through the ASEAN Economic Community, nurses can both address the recognized need of nursing services and promote health equity for the betterment of society.…”